A technique for the management of cardiac catheterization in children is described which combines axillary plexus block with basal sedation. The technique offers a quiet still arm with pronounced vasodilatation, permitting the use of larger catheters than usual, making sampling easier, and giving undamped pressure records.These factors, together with the absence of venospasm, make catheterization of an arm vein in young chiidren a feasible proposition; in addition arterial sampling via the brachial artery may be performed without further inconvenience to the child.
In a previous paperl, we reported upon a preliminary trial of bupivacaine for extradural analgesia. Our results, together with those of other workers2-6, suggested that a fullly randomised double-blind comparison between bupivacaine and lignocaine would be worthwhile.
MATERIALIt was decided to compare 0.5 % bupivacaine hydrochloride with adrenaline I :200,000 (bupivacaine) with 2 % lignocaine hydrochloride with adrenaline 1 :200,000 (lignocaine:) since these concentrations are roughly equipotent for the purposes of this trial; assessment of muscular relaxation was not a primary interest3. The: solutions were prepared in plain, paired ampoules, each containing 10.5ml. Each pair was labelled with a number only, so that none of the participants in the trial (patients, anaesthetists or post-operative nursing staff) was aware of the identity of the analgesic drug being used. The code, which remained in a sealed envelope throughout the trial, was designed so as to ensure that the drugs were used in random order. Operation and post-operative charts corresponding to the numbered ampoules were completed for each case.
METHODPatients included in the trial were those who, in the normal routine of this hospital, would be satisfactorily anaesthetized with a lumbar extradural block.Premedication consisted of either trimeprazine 25-50mg, or papaveretum 1Cb2Omg and hyoscine 0.4mg or atropine 0.6mg intramuscularly about 1 hour pre-operatively. Sixteen cases had no premedication. All patients who had had trimeprazine and such others who appeared anxious, were given diamorphine 1-2mg via an indwelling intravenous needle before the patient was positioned for the block.
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